PROJECT SUMMARY Candidate: Dr. Robert E. Freundlich, MD, MS is an Assistant Professor at Vanderbilt University Medical Center (VUMC). Dr. Freundlich has a strong background in clinical informatics, gained through his research fellowship and ongoing work as the Associate Medical Director of the Vanderbilt Anesthesiology and Perioperative Informatics Research Division (VAPIR). His long-term career plan is to become a physician- scientist capable of leveraging advanced informatics tools to conduct high quality pragmatic clinical trials in the intensive care unit and perioperative care. To achieve this, he will gain expertise in pragmatic clinical trial design, advanced use of a widely-available commercial electronic health record (EHR), executive leadership development, and board certification in clinical informatics. Research Project: More than half a million adult patients undergo cardiac surgery each year in the United States, 5-10% of whom will experience reintubation. Reintubation after cardiac surgery is associated with higher short- and long-term mortality, increased cost, and longer lengths of stay. As patients undergoing cardiac surgery are increasing in age, comorbidity burden, and receive increasingly complex cardiac surgical procedures, efforts to identify strategies that can effectively prevent reintubation are of critical importance. Career Development: Dr. Freundlich's career development plan integrates formal coursework with personalized training with his mentors and collaborators to 1) strengthen his methodologic foundation in the conduct of pragmatic comparative effectiveness trials; 2) develop expertise in the implementation of EHR- embedded clinical trial design; 3) advanced statistical modeling techniques to improve risk prediction; and 4) bolster his skills as a leader of a multi-disciplinary research team. Environment: VUMC is an established leader in biostatistics, perioperative informatics, and pragmatic clinical trial design and conduct. It is the ideal environment to foster Dr. Freundlich's development into a national leader in his field. Dr. Freundlich has identified experts at VUMC, each of whom is a leader in his or her field and will help mentor Dr. Freundlich towards his goal of research independence. Vanderbilt's Clinical and Translational Science Award (CTSA) funded ?Learning Healthcare System?, intended to facilitate research that uses novel methods to integrate clinical research into clinical care, will help Dr. Freundlich as he works on the proposed research and career development plans.